The symptoms of the Moss Free Clinic’s worsening condition are getting harder to ignore.
On a recent Tuesday, a dozen office chairs and filing cabinets spilled out into a first-floor hallway as the clinic rushes to vacate an upstairs space — used for screening patients — that it can no longer afford.
Then, there are the bills piled high on Executive Director Karen Dulaney’s desk, many of them previously unforeseen expenses adding up to nearly $200,000 a year.
With funds from a 2004 capital campaign that raised $10 million fully drained and the clinic’s longtime partnership with Mary Washington Healthcare strained following a rebuffed takeover bid last year, the prognosis for the clinic, which serves exclusively low-income patients, appears grim.
“A few months, probably,” Dulaney said of how long Moss can continue to operate under its current circumstances. “We can certainly cut back our services and cut back our staff to a level we can afford, but it will be a significant reduction in care for our patients, which is what we’re trying to avoid.”
Money problems and a proposal
The Moss Free Clinic moved into its current home at 1301 Sam Perry Boulevard in 2007, with approximately $4 million of the fund going toward the building’s construction, Dulaney said. The remaining $6 million was considered the clinic’s operating fund, managed by the Mary Washington Hospital Foundation.
In 2021, by which point the funds were depleted, hospital leadership made a presentation to Moss’s board of directors in which they proposed taking over the clinic.
“I don’t think that’s what our board was expecting to be the plan,” Dulaney said.
In a Feb. 23 “guest editorial” that was sent to the Fredericksburg Free Press along with other local media outlets, MWHC says it “offered to merge the services of the Moss Free Clinic into its integrated, equitable model to honor the legacy of Dr. Moss and the like-minded missions our organizations share.”
Dulaney said that the 21-member Moss board hired a consultant to consider the proposal and gain some clarity about how a clinic under MWHC might operate. In particular, Mo
ss’s leadership sought assurances that core services like dentistry and pharmacy (Moss fills prescriptions for 15 other clinics statewide) would continue under a new model. The clinic also inquired about the status of its paid staff and the roster of 33 volunteer physicians who provide regular care.
“In the board’s opinion, they didn’t feel like they got a lot of clarity or answers,” said Dulaney, who added that she was asked to and agreed to recuse herself in the discussions. “They were vague.”
Finally, in February 2023, the clinic’s board “respectfully declined” the offer from MWHC, Dulaney said.
A fraying connection
Cybersecurity was among the first concerns broached by MWHC, Dulaney said. The hospital expressed concern that Moss’s use of its network and phone system would leave it vulnerable to hackers. With little recourse, Moss purchased its own systems in the early part of 2023.
Later that year, MWHC informed Moss that it would no longer provide payroll and accounting support, which it had donated as a service since the clinic’s founding in 1993, according to Dulaney. After that support ended this past December, Moss began paying for a third-party vendor.
“We… explained that cybersecurity and legal risk required Mary Washington Healthcare to stop providing technology and business service to any [underlined] outside entity outside MWHC governance,” read the health care nonprofit’s Feb. 23 statement, which was signed by 28 individuals, including President and CEO Dr. Michael McDermott.
Historically, said Dulaney, Moss’s lease for the building on Sam Perry Boulevard was $1 per year, renewable for five years with the clinic paying for utilities out of its operations fund. When Moss reviewed the notice for its new lease this past October, however, the term was one year.
While the “base rent” of the new lease is still listed as $1, Dulaney said, a new line item of “additional rent” was listed for the first and second floors. Together, the new total approached $14,000 per month.
“As the board of the Moss Free Clinic is responsible for its governance and decision making, we honor its decision to decline our offer,” the MWHC statement reads in part.
‘We’re still that comprehensive hub’
Nurse practitioner Quintina Foster-Jackson considers her latest patient the best case she could possibly make for the clinic’s continued, independent existence.
The man, who is uninsured, was diagnosed with colon cancer after visiting an emergency room in Florida, where he lived at the time. Following emergency surgery and a brief stint in a rehab facility there, he was about to be discharged.
In other words, Foster-Jackson recalled, “They were going to release him onto the street.”
Fortunately for the man, he had family in the Fredericksburg area who knew about the Moss Clinic. They brought him to Virginia, where he’s been able to receive the full range of care he requires through the free clinic.
“Here, we’re able to get him oncology services, at no charge to him,” said Foster-Jackson, who has worked part-time at Moss for seven years. “And then all the other ancillary things he’s going to need: a gastroenterologist because of the type of cancer at no charge to him. We have staff here that helps fill out Medicaid paperwork.”
The clinic sees anywhere from 30-50 patients per day, Dulaney said. According to the clinic’s 2022 nonprofit Form 990 filing with the IRS (the most recent year available), Moss had 5,600 “on-site patient visits” and dispensed 61,000 prescriptions.
When a patient arrives at the clinic, staffers first evaluate their eligibility for treatment. To qualify, a patient must be uninsured, live in the Fredericksburg area’s planning district and have an income that’s less than 300% of the federal poverty line.
In its “guest editorial,” MWHC argued that the region’s “healthcare safety net has become much more resilient and robust,” since the Moss Clinic was founded in the early 1990s.
MWHC also says that in 2023 it provided $1.4 million in support to clinics including Central Virginia Health Services, Moss, the Fredericksburg Christian Health Center, the Guadalupe Free Clinic, the Living Water Community Clinic and the Micah Ecumenical Ministries Respite Facility. Combined, those clinics treat almost 10,000 patients annually, according to MWHC.
“It’s definitely true that the environment has changed,” Eric Fletcher, MWHC’s Senior Vice President and Chief Strategy Officer, said in a phone interview. “There are many, many more providers today than there were 30 years ago.”
While uninsured patients do have more options, a majority of Moss’s patients have significant transportation issues, Dulaney noted. The clinic’s location along the Fredericksburg Regional Transit bus line (F4 and F5 lines) increases access to care, and the holistic nature of Moss’s offerings helps patients navigate a medical system that can present more offshoots than a highway interchange.
“We’re still that comprehensive hub that gets patients where they need to be,” Foster-Jackson said.
Footing the bill
Dulaney suspects that MWHC doesn’t actually want to run a free clinic; rather, she said, Moss is desirable for its location.
Under new rules developed by the Centers for Medicare and Medicaid Services after the passing of the Bipartisan Budget Act of 2015, hospitals can bill at a higher Medicare reimbursement rate for facilities within 250 yards of the main campus.
Facilities that fit that definition — like Moss or Kids’ Station, where MWHC plans to build a 24,500 square-foot clinic — “will have a significant financial impact for hospitals, particularly those that are actively planning for an off-campus department,” reads an explainer on the website of ECG Consultants, which works with major healthcare providers.
“It’s definitely a factor, as it is with every hospital,” Fletcher said of the enhanced reimbursement rates. “One of the things to understand is that the payments we receive from Medicare or Medicaid don’t even cover the cost of care.”
Dulaney was more blunt: “If they can have our whole first floor for whatever purpose, that would be a money-making venture for them,” she said.
An uncertain prognosis
Healthcare providers at Moss are aware of the existential crisis facing their workplace, even if they manage to conceal their concern beneath scrubs.
“I come in like Moss Clinic is going to be here forever, like I’m going to retire here,” Foster-Jackson said.
That won’t be possible unless something changes, however. Dulaney revealed that the MWHC board of trustees and Moss’s Board of Directors met on March 5 for what she hoped would be a productive conversation.
Neither Dulaney nor Fletcher would comment as to what was discussed at the meeting.
“What we want is the collaborative partnership with the hospital system that we have had until recently,” Dulaney said. “We really believe that working together is the way to do this.”
One potential solution floated by Dulaney is a scenario in which MWHC allows the clinic to operate in another of its properties, albeit farther from the main hospital campus. Regardless, Moss remains in dire need of a cash infusion.
Dulaney estimates that the clinic will need at least half a million dollars a year to supplement its other funding sources, which include the United Way and the state. According to the Form 990 filing, Moss received $975,353 in government grants in 2022.
But a true clean bill of health will likely require the sort of groundswell that preceded the first capital campaign nearly two decades ago.
“The little bit of solace that we have is that, yes it was 20 years ago, but this community did raise 10 million for this organization,” Dulaney said.
Mary Washington Healthcare, an individual or organization central to this story, is a major donor to the Free Press. Donors do not influence newsroom operations.
